肾损伤、脂质异常与清蛋白尿糖尿病肾病及非清蛋白尿糖尿病肾病发生的关系  

Correlation of kidney injury and dyslipidemia with albuminuria and non-albuminuria DKD occurrence

作　　者：杨渝伟[1] 陈小红[1] 俸家富[1] 彭玲 胡冬[1] YANG Yuwei;CHEN Xiaohong;FENG Jiafu;PENG Ling;HU Dong(Department of Clinical Laboratory,Mianyang Central Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]四川省绵阳市中心医院检验科,四川绵阳621000

出　　处：《国际检验医学杂志》2020年第16期1944-1949,1953,共7页International Journal of Laboratory Medicine

基　　金：四川省科技厅支撑计划项目(2015SZ0117);四川省科技厅应用基础项目(2019YJ0701)。

摘　　要：目的探讨常见肾损伤和脂质异常标志物与清蛋白尿糖尿病肾病(ADKD)及非清蛋白尿糖尿病肾病(NADKD)发生的关系,及其对NADKD的预测价值。方法将2016-2018年该院连续3次每月随访的糖尿病患者1504例,按照美国糖尿病协会(ADA)指南分为单纯糖尿病(SDM)组(n=869)、NADKD组(n=133)和ADKD组(n=502),选择同期体检健康者201例纳入健康对照(HC)组。以HC组、SDM组和ADKD组建立ADKD试验组(n=1572),选择738例3次尿清蛋白/肌酐比值(ACR)<30 mg/gCr的SDM患者与HC组、NADKD组建立NADKD试验组(n=1072),分析肾功能和脂代谢指标与ADKD及NADKD的关系、诊断性能和发生NADKD风险程度。结果在所观察的肾功能[ACR、估算肾小球滤过率(eGFR)、中性粒细胞脂质相关运载蛋白(NGAL)、尿素(Ure)、肌酐(Cr)和胱抑素C(CysC)]和脂代谢[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和同型半胱氨酸(HCY)]指标中,除Ure外,均与ADKD呈偏相关(|rp|=0.100~0.256,P<0.05);但仅ACR、eGFR、NGAL、HCY与NADKD呈偏相关(|rp|=0.098~0.239,P<0.05)。受试者工作特征(ROC)曲线分析显示,诊断ADKD时AUCACR=0.890、AUCeGFR=0.869和AUCNGAL=0.843明显高于其他指标的AUC(Z=2.244~7.395,P<0.05),但ACR+eGFR联合其他任意一项指标的诊断性能并不比ACR+eGFR更佳(Z=0.551~1.835,P>0.05);诊断NADKD时AUCeGFR=0.982和AUCNGAL=0.969明显高于AUCHCY和AUCCr(Z=5.803~10.710,P<0.001),并且AUCeGFR+NGAL也明显高于AUCACR+eGFR(Z=3.677,P<0.001)和AUCeGFR+HCY(Z=3.693,P<0.001)。ACR对NADKD的诊断性能极差,但其判断界值(10.4 mg/gCr)与健康人群参考上限极为接近。分层风险分析证实,对于ACR≥10 mg/gCr的NADKD患者,NGAL比HCY更具有风险性(OR=41.28、13.71,P<0.05)。结论肾损伤与ADKD及NADKD的发生密切相关。对于NADKD疑似患者,若ACR>10 mg/gCr,则应同时关注eGFR和NGAL的变化,以早期诊断NADKD。Objective To explore the correlation between common kidney injury and dyslipidemia markers with albuminuria diabetic kidney disease(ADKD)and non-albuminuria diabetic kidney disease(NADKD),and their predictive values for NADKD.Methods From 2016 to 2018,1504 patients with diabetes followed up 3 times every month were included in Mianyang Central Hospital,who were divided into simple diabetes(SDM,n=869),NADKD(n=133)and ADKD(n=502)group according to ADA guidelines,and 201 healthy controls(HC group)in the same period were randomly selected.ADKD database(n=1572)was composed of HC group,SDM group and ADKD group,while 738 patients with urinary albumin/creatinine(ACR)<30 mg/gCr for 3 times in SDM group were selected to establish NADKD database(n=1072)with HC group and NADKD group.Then the relationship,diagnostic performance and risk were analyzed between kidney function and lipid markers with ADKD and NADKD.Results Among the observed markers of kidney function[ACR,estimation of glomerular filtration rate(eGFR),neutrophil lipid associated transport protein(NGAL),urea(Ure),creatinine(Cr),cystatin C(CysC)]and[lipid total cholesterol(TC),triglyceride(TG)high-density lipoprotein cholesterol(HDL-C)low-density lipoprotein cholesterol(LDL-C)and homocysteine(HCY)],except Ure,all were partially correlated with ADKD(|rp|=0.100-0.256,P<0.05),but only ACR,eGFR,NGAL and HCY partially correlated with NADKD(|rp|=0.098-0.239,P<0.05).As ROC analysis shown,when diagnosing ADKD,AUCACR=0.890,AUCeGFR=0.869 and AUCNGAL=0.843 were significantly higher than AUC of the others(Z=2.244-7.395,all P<0.05),but the diagnostic performance of ACR+eGFR combined with any other marker was not better than that of ACR+eGFR(Z=0.851-1.835,P>0.05).When diagnosing NADKD,AUCeGFR=0.982 and AUCNGAL=0.969 were significantly higher than AUCHCY and AUCCr(Z=5.803-10.710,all P<0.001),in addition AUCeGFR+NGAL was significantly higher than AUCACR+eGFR(Z=3.677,P<0.001)and AUCeGFR+HCY(Z=3.693,P<0.001).Stratified analysis confirmed that NGAL was more risky than HCY in NADKD pa

关 键 词：糖尿病肾病 清蛋白尿 中性粒细胞明胶酶相关脂质运载蛋白 脂质异常 

分 类 号：R587.2[医药卫生—内分泌]